Health state utilities for non small cell lung cancer.
BACKGROUND
Existing reports of utility values for metastatic non-small cell lung cancer (NSCLC) vary quite widely and are not all suitable for use in submissions in the UK. The aim of this study was to elicit UK societal based utility values for different stages of NSCLC and different grade III-IV toxicities commonly associated with chemotherapy treatments. Toxicities included neutropenia, febrile neutropenia, fatigue, diarrhoea, nausea and vomiting, rash and hair loss.


METHODS
Existing health state descriptions of metastatic breast cancer were revised to make them suitable as descriptions of metastatic NSCLC patients on second-line treatment. The existing health states were used in cognitive debrief interviews with oncologists (n = 5) and oncology specialist nurses (n = 5). Changes were made as suggested by the clinical experts. The resulting health states (n = 17) were piloted and used in a societal based valuation study (n = 100). Participants rated half of the total health states in a standard gamble interview to derive health state utility scores. Data were analysed using a mixed model analysis.


RESULTS
Each health state described the symptom burden of disease and impact on different levels of functioning (physical, emotional, sexual, and social). The disutility related to each disease state and toxicity was estimated and were combined to give health state values. All disease states and toxicities were independent significant predictors of utility (p < 0.001). Stable disease with no toxicity (our base state) had a utility value of 0.653. Utility scores ranged from 0.673 (responding disease with no toxicity) to 0.473 for progressive disease.


CONCLUSIONS
This study reflects the value that society place on the avoidance of disease progression and severe toxicities in NSCLC.
Nafees
Beenish
B
United BioSource Corporation, UK, 20 Bloomsbury Square, London, WC1A 2NS, UK. beenish.nafees@unitedbiosource.com
Stafford
Megan
M
Gavriel
Sonia
S
Bhalla
Shkun
S
Watkins
Jessamy
J
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D017326:Clinical Trials, Phase III as Topic; D003710:Demography; D018450:Disease Progression; D064420:Drug-Related Side Effects and Adverse Reactions / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011594:Psychometrics / Q000295:instrumentation / Q000592:standards*; D011788:Quality of Life; D018434:Sickness Impact Profile; D016896:Treatment Outcome; D006113:United Kingdom